Title 33, Chapter 20, Section 3
As used in this chapter, the term:
(1) "Beneficiary" or "covered dependent" means a person designated
in the subscription certificate or application therefor of a
subscriber as entitled to health care service with respect to whom
appropriate periodical payments are made, all subject to
acceptance by the health care corporation.
(2) "Health care corporation" means a corporation established in
accordance with the provisions of this chapter to administer one
or more health care plans.
(3) "Health care plan" means a plan or arrangement under which
health care services are or may be rendered to a subscriber or a
covered dependent or other beneficiary at the expense of a health
care corporation in consideration of periodical payments made by
the subscriber or another in his behalf.
(4) "Health care services" means the examination or treatment of
persons for the prevention of illness or the correction or
treatment of any physical or mental condition resulting from
illness, injury, or other human physical problem and includes but
is not limited to:
(A) Hospital services which include the general and usual care,
services, supplies, and equipment furnished by hospitals;
(B) Medical services which include the general and usual
services and care rendered and administered by doctors of
medicine, doctors of dental surgery, and doctors of podiatry;
(C) Other health care services which include appliances and
supplies; nursing care by a registered nurse or a licensed
practical nurse; care furnished by such other licensed
practitioners as may be expressly approved by the board of
directors from time to time; institutional services including
the general and usual care, services, supplies, and equipment
furnished by health care institutions and agencies or entities
other than hospitals; physiotherapy; ambulance services; drugs
and medications; therapeutic services and equipment including
oxygen and the rental of oxygen equipment; hospital beds; iron
lungs; orthopedic services and appliances including wheelchairs,
trusses, braces, crutches, and prosthetic devices including
artificial limbs and eyes; and any other appliance, supply, or
service related to health care.
(5) "Income at risk" means the amount of income earned on an
account in which a risk of underwriting loss due to adverse claims
experience exists. In the case of any risk account as to which the
rate is not established directly by the health care corporation,
income at risk shall be the sum total of benefits paid and
administrative costs incurred for such account for which the
health care corporation has been or will be reimbursed.
(6) "Participating facility" means a hospital, extended care
facility, or other facility, institution, agency, or entity
providing health care services which agrees in writing with a
health care corporation to provide services specified in the
subscription contracts issued by the corporation at such rates of
compensation as shall be determined by the board of directors of
the corporation and which agrees to abide by the bylaws, rules,
and regulations of the corporation applicable to participating
facilities. A participating facility must be licensed or approved
as such by the appropriate agency of this state, some other state,
or the federal government or shall meet such requirements as shall
be established by the health care corporation if no regulatory
license or approval is required.
(7) "Participating physician" means a doctor of medicine licensed
to practice medicine or surgery in this state under Chapter 34 of
Title 43, a dental surgeon licensed to practice dental surgery in
this state under Chapter 11 of Title 43, or a podiatrist licensed
to practice podiatry in this state under Chapter 35 of Title 43
who agrees with a health care corporation to perform medical
services under the conditions specified in the subscription
contracts issued by the corporation.
(8) "Person" means a natural person, a partnership, an
association, a common-law trust, or a corporation.
(9) "Provider" means any physician, hospital, or other person who
is licensed or otherwise authorized in this state to furnish
health care services.
(10) "Subscriber" or "member" means a person to whom a
subscriber's certificate is issued by a health care corporation,
which certificate sets forth the kinds and extent of the health
care services which may be all or a part of the total health care
services used by or provided to a subscriber for which the
corporation is liable to make total or partial payment.
(11) "Subscriber surplus" means the excess of the admitted assets
of a health care corporation over its liabilities as reported in
the annual statement filed with the Commissioner.
(12) "Surviving corporation" means a health care corporation which
(A) The surviving corporation in a merger which includes one or
more health care corporations;
(B) A health care corporation which has amended its articles of
incorporation to become a corporation governed by Chapter 2 of
Title 14, the "Georgia Business Corporation Code"; or
(C) The subsidiary of a corporation described in subparagraph
(A) or (B) of this paragraph.